Back pain is, unfortunately, a very common condition. According to NIH, lower back pain alone afflicts at least 80% of adults at some point in their lives. Some back pain causes can even lead to symptoms in other parts of your body. There are many reasons why this happens, and one of them is foraminal stenosis. That’s quite a mouthful, but what does this condition really mean for you and your health? Read on to learn what foraminal stenosis is, what it feels like, how it’s diagnosed, and how you can treat it if you do have it.
Your spine is made up of 33 small bones called vertebrae. Between each vertebra is a small space, or foramen, that allows nerves to thread through your spine. In a healthyspine, the foramen are large enough to comfortably accommodate these nerves. But sometimes, for a variety of reasons, a foramen becomes compressed. The bones press closer together, potentially putting pressure on the nerves between them.
Foraminal stenosis is a type of spinal stenosis, which occurs when the spinal column narrows and puts pressure on the spinal cord. But there are differences between the two conditions. As already discussed, foraminal stenosis, also called neural foraminal stenosis, occurs when a foramen (rather than the spinal column) narrows. This can happen anywhere in your spine, from your lower neck all the way down to your lower back.
The location of the compression will determine where in your body you feel symptoms—assuming you feel any symptoms at all. Neural foraminal stenosis can be asymptomatic; you might not realize you have it unless and until a nerve gets caught in the narrowed foramen.
However, you may see this condition referred to by more specific names depending on whether the affected nerve is, such as your:
The most common of the three is lumbar foraminal stenosis.
In most cases, symptoms only manifest on the side of your body where the nerve is compressed. But in cases of bilateral foraminal stenosis, the nerve is pinched on both sides of the spine, so you will experience symptoms on both sides of your body.
There are many reasons why this condition develops. You might already have an idea of what the cause is in your case; for example, if you’ve been diagnosed with a bone condition, such as arthritis in your back, that could be the reason.
But regardless of whether you have a strong suspicion or no idea at all, it’s important that you go to a doctor for an examination and a formal diagnosis. We will discuss the diagnosis process and why it is so important later in this post.
Here are a few of the most common foraminal stenosis causes.
Arthritis is one of the main culprits behind foraminal stenosis. This condition can affect your vertebrae in numerous ways. It is best known for causing joints to become inflamed, but it can also weaken the bones, as is the case with osteoarthritis.
Weak bones are more likely to move out of place than strong ones. Also, sometimes arthritis leads to bone spurs. These are bony protrusions that grow over existing bone. When they develop in the spine, they may block the foramen.
If you have suffered trauma to your back—for example, if you were in a car accident, or if you hurt yourself while playing a sport—you may be at increased risk for foraminal stenosis.
There are numerous conditions that can affect the bones in your spine and that, in turn, can lead to foraminal stenosis. Herniated discs (where the cushioning spinal disc between vertebrae slips out of place) and degenerative discs (where the vertebrae themselves move out of alignment) can both put pressure on spinal nerves. Spondylolisthesis occurs when a vertebra in your lower back shifts down onto the one beneath it.
As with foraminal stenosis itself, all of these conditions may be completely asymptomatic unless and until the vertebra or spinal disc starts to press on a nerve.
Some illnesses can increase your risk of foraminal stenosis. Various bone diseases—including Paget’s disease of bone, when your body produces bones that are weaker than they’re supposed to be—can lead to a narrowed foremen.
Tumors have also been known to cause this condition, but try not to worry too much about that. Only in very rare cases is foraminal stenosis caused by cancer.
Symptoms will vary depending on your condition’s severity and the location of the affected foramen. Your symptoms may ebb and flow, and they may never go away entirely.
Four of the most common foraminal stenosis symptoms are:
Other symptoms include muscle spasms and trouble with walking or maintaining your balance.
In cases of cervical foraminal stenosis, your symptoms will likely be focused in your upper body, particularly your arm and hand. You may feel pain, tingling, or numbness radiating down the affected limb.
Thoracic foraminal stenosis symptoms will manifest all the way around your upper torso. Symptoms may worsen during or immediately after performing certain activities.
The symptoms of lumbar foraminal stenosis often radiate from the lower back into the leg, foot or glute.
And finally, in cases of bilateral foraminal stenosis, whatever symptoms you have will manifest on both sides of your body.
The good news is that this condition is typically very manageable. Symptoms are usually controlled well with conservative therapies. We’ll discuss some of the most common treatment methods later on.
There are some rare cases where foraminal stenosis becomes serious enough to warrant a reevaluation of your treatment regimen. Your symptoms may get worse over time, necessitating more drastic treatments to keep symptoms in check.
Dealing with a worsening medical condition can be difficult and upsetting, and you should keep your doctor updated on how you’re feeling so that they can guide you towards better, more effective treatments. However, gradually worsening symptoms do not generally require an emergency trip to the doctor. By contrast, if your symptoms begin to rapidly get worse, seek medical help immediately.
Sometimes, lumbar stenosis leads to cauda equina syndrome. The symptoms of this serious condition include:
If you are experiencing these symptoms, get help immediately. Delaying treatment of cauda equina syndrome can result in permanent nerve damage, including paralysis.
Only a physician can formally diagnose you. If you suspect you have this condition, let your doctor know and explain what symptoms you have been experiencing.
Your doctor will review your medical history and run tests to determine if you do have foraminal stenosis. These tests may include one or more of the following:
A magnetic resonance imaging (MRI) scan uses magnetic fields and radio waves to create a picture of your internal organs.
An X-ray utilizes radiation to create a picture of your bones, enabling your doctor to see your spine without surgery.
A computed tomography (CT) scan also utilizes X-rays, but a CT scanner will take many different X-ray images and combine them into a more detailed picture than a single X-ray could produce.
A bone scan involves injecting a radioactive tracer into your bloodstream. This will make the resulting image clearer so any abnormalities are easier to spot.
A myelogram is another kind of X-ray. Your doctor will inject a contrast agent into your back before taking the X-ray. As with the tracer used in the bone scan, the contrast agent will result in a better image.
An electromyograph determines if there is damage to your nerves or muscles. Your doctor will first apply electrodes and then needles to the affected area to test how your muscles and nerves interact with each other.
Your doctor will decide which of these tests is right for you. The types of tests they run will depend on several factors, including your health, other medical conditions you have, and where in your body you are experiencing symptoms. Some of these tests will help your doctor directly diagnose foraminal stenosis, while others will eliminate other potential causes of your pain.
Even if you already feel completely sure that you have foraminal stenosis, it is important to let your doctor perform their own examination and tests. This way, they can rule out potentially life-threatening pain causes, including cancer.
Once you have an official diagnosis, you and your doctor can discuss which treatment options are right for you. Foraminal stenosis treatment options range from holistic methods you can do on your own at home to more interventional measures performed in a clinical setting. Always check with your doctor before starting any treatment regimen, as not all treatments are safe for all patients in all situations.
One critical treatment is exercise. Certain exercises can ease pain and strengthen the body, making it better able to cope with illness and injury. Medications, either over-the-counter or prescription, may help relieve pain as well. If these treatments are not enough to relieve your pain, you can also try heat/cold therapies and physical therapy.
In extreme cases, as a last resort, your doctor may recommend either injections or surgery to relieve foraminal stenosis pain. Injections deliver medication, such as corticosteroids, directly into the painful area. Your doctor may also suggest performing a temporary spinal nerve block. Spinal nerve blocks may treat chronic pain that doesn’t respond to other kinds of treatments. The temporary type usually involves a surgeon injecting an anesthetic directly into the affected area.
When it comes to surgery, your doctor may decide to perform either a permanent spinal nerve block or a foraminotomy. Unlike the temporary spinal nerve block, the permanent type involves surgically cutting off or damaging the affected nerve. A foraminotomy is when a surgeon physically enlarges the foramen to relieve the pressure on the nerve.
Again, both surgery and injections are not first-line treatments for foraminal stenosis pain. In the overwhelming majority of cases, you will find pain relief with at-home or conservative treatments.
Sleep is critical to your health and overall sense of wellbeing. But getting enough sleep may be easier said than done if you are experiencing nocturnal back pain. Chronic middle back pain while sleeping can disrupt your sleep enough to affect not just your nights, but yfour days as well. Keep reading for tips on how to manage or even eliminate middle back pain while sleeping.
Your middle back is also referred to as the thoracic region. It roughly encompasses the area from the base of your neck to just below your ribcage, and includes the space between your shoulder blades.
Middle back pain at night is sometimes caused by something simple, such as bad posture or twisting too quickly. In these cases, the pain is usually temporary and you’ll find relief fairly easily with proper care and patience. In other cases, however, back pain has a more serious cause that will require professional intervention.
Middle back pain while sleeping may not be as widely discussed as other kinds of nocturnal back pain, but it can be just as distressing and must be taken just as seriously. Here are the major causes of middle back pain while sleeping.
Much has been made about the amount of time people spend sitting — whether in the car, at work, or in front of a screen — and the effects this can have on your health and lifespan. But it’s not just sitting itself that can impact your life; it’s also the way you sit.
Spending prolonged periods of time leaning forward or hunching over can strain your back, leading to pain throughout your neck, shoulders, and back.
Back injuries run the gamut from minor to life-changing.
In cases of minor injuries, such as those caused by improper lifting technique or turning the wrong way, your pain will likely go away by itself within days or weeks. But if the injury is serious enough, it can lead to long-term problems, including chronic pain.
You have discs all along your spine in between each pair of vertebrae. Each disc is filled with a jelly-like substance that keeps your backbones from grinding against each other when you move.
A herniated disc occurs when one of the discs breaks open. A bulging disc is a similar condition, but instead of breaking open, the disc slips out of place and the inner substance “bulges” outwards but doesn’t rupture. Both conditions may be asymptomatic, or they may cause symptoms like pain, numbness, and weakness.
Herniated and bulging discs affect both the surrounding vertebrae and, often, the nearby nerves. These injuries are most common in the lower back, but they can also occur in the middle and upper back and even in the neck.
A vertebral compression fracture, when one of your vertebrae cracks or collapses, is usually the result of osteoporosis or a traumatic injury, like a fall or an accident.
Vertebral compression fractures don’t always cause symptoms. When they do, the symptoms tend to vary widely, but there are some commonalities. These include pain and a permanent curve of the spine (kyphosis). The severity of symptoms will depend on the severity of the fracture and may worsen over time.
Most cases of middle back pain while sleeping are not serious. It is certainly disruptive, annoying, and even upsetting, but the underlying causes do not pose an immediate health risk. The symptoms can be safely treated with more conservative remedies.
However, as mentioned earlier, some middle back pain causes are more serious than others. If your middle back pain is accompanied by numbness and/or tingling, there may be underlying nerve damage. This can be caused by multiple conditions, some potentially dangerous, so it’s important to visit your doctor as soon as possible.
Further, any middle back pain that occurs with loss of feeling in your limbs or loss of bowel control is an emergency condition. Contact your doctor immediately if this occurs.
In addition, if you’ve tried some basic at-home remedies and your symptoms are still so severe that you can’t sleep well, make an appointment with your doctor as soon as you can. Without proper rest, your body and mind will quickly become exhausted. Any and all medical issues that prevent you from sleeping properly should be taken care of as quickly as possible.
Sleeping with middle back pain can be a challenge, but it isn’t impossible. Some remedies require making a purchase, while you can test out others tonight for no cost.
Below are some tips on how to sleep with middle back pain.
Most people use pillows to provide support for their head and neck while they sleep. But you can also use pillows to support your back and minimize pain while sleeping.
No matter which sleeping position you favor, there is a way to arrange your pillows to ease your middle back pain and get a better night’s rest. Try pillows between the knees if you’re a side sleeper or a small one under your knees if you sleep on your back. Try a different pillow to manage your neck pain if it’s leading to back issues.
Not working? Talk to your doctor for suggestions that could work for you.
When it comes to managing back pain at night, not all sleeping positions are created equal. For example, sleeping on your stomach forces your neck to rest in unnatural positions, straining your back.
The Cleveland Clinic offers this guide to evaluate your sleeping position(s) and to figure out whether it might be necessary for you to try some new ones. Our earlier post also discusses at length how certain sleeping positions can cause back pain and which ones may be better for you.
Back pain can be exacerbated by an old, uncomfortable, or unsupportive mattress. One study suggests that medium-firm mattresses provide the best sleep quality. But don’t think of this as a hard and fast rule. You know your body better than anyone, and you are the only one who can choose the best mattress for you.
While mattress shopping, there are several things you can do to make sure you pick the right one. Before making a purchase, do some research on which mattress brand, style, and firmness might work for you. Some of this work can be done online, but it’s also important to go to the store, ask questions of the sales rep, and test out the mattress you’re considering. A mattress is a big investment, so take your time and do your homework before making a final decision. See if you can find options with a good return policy or risk-free trial period.
If a new mattress just isn’t in the budget at the moment, try a foam mattress topper. These are generally much cheaper than a full mattress, but they can still provide additional support if you need it.
Even after the night is over and you’re ready to start the day, you still have to get out of bed. As with choosing a sleeping position, there is a right way and a wrong way to do this.
Verywell Health provides a step-by-step guide on how to get out of bed without hurting your back.
If you’ve tried the tips above and still can’t sleep, then it’s time to move away from coping with middle back pain while sleeping and start actively treating it.
Fortunately, there are a multitude of ways to treat back pain. However, not all of them may work for you, and some may even be harmful, depending on your back pain cause or underlying medical conditions. Because of this, it’s always important to consult with your doctor before beginning any new treatment regimens.
Because poor posture is such a common cause of back pain that no matter who you are, it’s probably a good idea to pay more attention to how you sit and stand throughout the day.
Do you hunch your shoulders for hours as you work on the computer? Do you slouch when you walk? Get into the habit of assessing your posture regularly and adjusting it as necessary. Here’s some tips for improving your posture.
One of the simplest yet most useful ways to combat middle back pain is a combination of rest and gentle exercise.
Using your back muscles on a regular basis keeps them strong and helps them recover more quickly. That said, don’t push yourself too hard. If you feel any pain or discomfort while exercising, stop, rest, and modify the exercise if you try it again.
Heat and/or cold therapy is a time-honored method of pain relief. While many stores and pharmacies carry products such as heating pads to provide this treatment, you don’t need to buy anything if you don’t want to. Ice wrapped in a towel or a hot shower can also work.
These treatments are best done before or as you’re settling into bed. Do not use heat or cold therapy while sleeping.
Pain of all kinds is often treated with medication. Over-the-counter medicines like ibuprofen or acetaminophen are often enough to help you find relief for pain flare-ups.
If your pain is severe, you may need to get a prescription for a stronger medication. Regardless of which kind of medicine you take, be sure to follow all instructions and to never take more than the recommended dose. Talk to your doctor about any risks or side effects.
A physical therapist can help you reduce your pain and increase your range of motion.
When you go in for a visit, your physical therapist will examine you and determine what treatment or combination of treatments will help your back heal. You’ll work with them closely as they show you correct form for these exercises and lead you through exercise routines.
If you have suffered from an injury, you may need to wear a back brace for several weeks. This can help minimize pain and prevent re-injury. On the other hand, using a brace for a long time may weaken your back muscles.
As with all treatments, discuss the pros and cons with your doctor before you try it.
In some rare cases, more drastic solutions are needed to resolve middle back pain while sleeping. For chronic pain that doesn’t respond to more conservative treatments, you may need to consider surgical options with your doctor.
The type of surgery you undergo will depend on your middle back pain cause. For example, herniated disc pain may be treated by removing part or all of the affected disc in a procedure called a discectomy. A vertebral compression fracture sometimes requires a vertebroplasty, during which bone cement is injected into the spine to strengthen the damaged vertebra.
Chronic fatigue syndrome (CFS) is a complex condition that goes by many names, such as chronic fatigue immune dysfunction and myalgic encephalomyelitis. It is characterized by extreme fatigue or tiredness that does not go away with bed rest. Chronic fatigue syndrome also has no discernible medical cause and can worsen when a person undergoes physical or mental activity. Symptoms can limit the everyday activities someone can enjoy as well as affect other parts of their life including work, family, and friends. In this post, we talk about some chronic fatigue treatments you can try to resolve symptoms and get back to your life.
Chronic fatigue syndrome is a disorder that is often misdiagnosed because its symptoms are common in other illnesses. The central symptom that defines CFS is extreme fatigue that lasts for more than six months, but there are many others that come along with this condition as well. According to the Centers for Disease Control, the following are symptoms that are used to diagnose chronic fatigue syndrome. A person must suffer from at least four of these to be diagnosed with chronic fatigue syndrome:
Malaise: The onset of extreme exhaustion and sickness following physical or mental exertion that lasts more than 24 hours
Cognitive issues: Lapse in memory, concentration, or complex information processing
Those who have chronic fatigue syndrome will notice a drastically lower level of energy than before they had this condition. This disorder also tends to occur alongside other illnesses such as fibromyalgia, irritable bowel syndrome, multiple chemical sensitivity, and orthostatic intolerance. If you believe you have chronic fatigue syndrome or any other illness, make sure to tell your healthcare professional.
Even with the current wave of research, it is still not known what exactly causes chronic fatigue syndrome. It is possible that it is caused by multiple factors at once. Many different factors have been studied in an attempt to find the cause. The following may be linked with a patient developing chronic fatigue syndrome:
Many different viruses have been researched, but none of them have been exclusively linked to the disorder. Some research has shown that the Epstein-Barr, Ross River, Human Herpesvirus 6, and Coxiella burnetti virus may create conditions that meet the criteria for CFS.
Many patients with chronic fatigue syndrome produce lower levels of cortisol and other hormones, which can greatly affect many other parts of the body. This underproduction is usually prompted by an emotional or physical stress event and is known to be a common pre-onset trigger. However, these production levels are still within a normal acceptable range and seem to happen in other illnesses.
People who develop chronic fatigue syndrome often have abnormal immune responses, such as particular T-cell activation markers and intolerance to some foods or medications.
Causes are still being explored, but scientists have discovered various risk factors that can increase your chance of developing chronic fatigue syndrome.
Sex: Women tend to be two to four times more likely to develop this condition versus men.
Age: It most commonly affects people in their 40s and 50s.
Family history: Sometimes, chronic fatigue syndrome is developed by members within the same family. This indicates a possible genetic link, although one has yet to be discovered.
Overall, adults are more likely to develop this condition than children and its incidence seems to be found in all races equally.
Of the up to the four million people in the U.S. who have chronic fatigue syndrome, only about 20% have actually received a proper diagnosis. This is because diagnosing this condition is a difficult process. Currently no one diagnostic test or sign can conclusively point to this disorder.
The process to be diagnosed is complicated further as it requires a variety of tests to rule out other similar conditions that may cause the same symptoms. This can be a problem as chronic fatigue syndrome can vary in severity and the symptoms can wax and wane, so a discernable pattern is not always easy to pin down.
Three critera have to be met if a diagnosis of chronic fatigue syndrome is to be determined:
Unexplained and persistent fatigue for six months that cannot be relieved by rest
This fatigue must greatly interfere with everyday activities
Four of the eight symptoms listed above must be present
The basic process that is used in the diagnosis process is laid out as follows:
A doctor will take a detailed medical history of the patient
The patient will undergo a thorough physical and metal examination
A multitude of tests will be required while trying to rule out other conditions
The CDC provides a more in-depth explanation of the diagnosis steps and the numerous tests that you might need.
This syndrome can be debilitating to the person suffering but also devastating to loved ones and caregivers. While researchers continue to study potential treatments, here are some current treatment options for chronic fatigue syndrome. There is no specific process or drug that can treat chronic fatigue syndrome. Managing this condition requires a team of professionals to help develop a personalized treatment plan that is best suited to each individualized patient.
Beyond that, there are a few lifestyle changes that can be made to help relieve and prevent some of the symptoms. These include:
Develop a sleep routine: Sleep hygiene is key for good health. Set a schedule and keep to it. Make sure to avoid problem products like caffeine and alcohol. Keeping a clean and clutter-free bedside table (and room in general) also helps promote sleep, as does going to bed at the same time and shutting off all screens (TV and computer) at least two hours before bedtime.
Try to reduce stress: Try meditation or yoga or whatever works for you. The point is to make time every day to relax and burn off some emotional stress.
Don’t overdo it: Make sure you don’t push yourself too hard even on the best days. A great way to have all of those symptoms come crashing back is to overexert yourself.
Lack of vital nutrients can contribute to fatigue and lack of energy. It is important to eat whole foods that are a vital source of iron and magnesium to keep iron levels in the blood high and increase oxygen levels in the blood and muscles. Many people do not get their recommended daily dose of eight to 18 milligrams of iron and 310 to 420 milligrams of magnesium daily.
Although supplements are an option, reach first for leafy greens, white beans, oatmeal, grass-fed beef, pumpkin seeds, and spinach to concentrate on upping levels of both vital nutrients naturally. Add vitamin C to increase absorption of iron in the blood and help build up your immune system at the same time!
One of chronic fatigue syndrome’s primary symptoms is the inability to have restful sleep. Although prescription sleeping medication is an option, long-term use can be dangerous and habit forming. Several supplements may help promote quality sleep without a prescription.
Melatonin: The body produces melatonin on its own to signal the brain that it is time for rest, but sometimes it does not produce enough. You can prompt your brain to begin melatonin production by keeping lights in the bedroom dark when it is time for bed. If this does not help, start with a low dose of a melatonin supplement (500 mg) and see if that helps improve your rest.
Theanine: Theanine is an amino acid that improves the quality of sleep. The tricky part is that it is found naturally in green and black teas, both of which contain caffeine. You could try decaf versions of those teas, or try a supplement. Take 100-200 milligrams 30 to 60 minutes before bedtime.
Unfortunately, sometimes sleep is elusive, and you may still have things to do the following day. There are natural supplements that can improve energy too:
L-Ornithine: A body suffering from chronic fatigue syndrome often has too much ammonia in the blood. This ammonia can make the brain foggy and less alert. L-Ornithine can help with that foggy-brain feeling and increased alertness and mental acuity during the day. The dosage is two to six milligrams.
Glycine: After a poor night’s sleep, glycine is an amino acid that may help improve cognitive performance the next day. Three daily grams can help clear up your thinking and sharpen your mind.
Coping with a chronic condition can be mentally taxing, and many with chronic fatigue syndrome also battle depression and anxiety. Antidepressants can help ameliorate the effects of depression, some of which contribute to even more fatigue and a deeper sense of malaise.
Used carefully and under a doctor’s supervision, prescription sleeping medication can also help provide a full, restful night of sleep when it is desperately needed. A person’s outlook can change drastically with a good night’s rest, and this may enable them to work with other treatments during the day.
This type of exercise therapy is designed by a physiotherapist for each individual patient.
The therapist will evaluate the chronic pain patient. Then, they’ll design an exercise program that gradually increases in duration and intensity as needed. Exercise can improve mood and quality of life, but chronic fatigue patients often feel as if they can’t muster the energy to do anything. This type of exercise takes that into account.
When combined with graded exercise therapy, CBT helps patients change their mindset surrounding their chronic fatigue. This does not tell them that it’s all in their head. Instead, it helps them to reframe their challenges and focus more on improvements and steps forward.
Many chronic fatigue syndrome patients report success with alternative treatments such as acupuncture, yoga, meditation, and t’ai chi. Using these treatments can be helpful when a patient does not want to add prescription medications, or they feel as if they need to incorporate more holistic approaches to their treatment plan.
Chiropractors may best be associated with spinal adjustments and the popping sound that many people’s bodies make as their musculoskeletal systems click back into proper alignment. That noise is actually the sound of pockets of gas released by the joints as they fall back into place. But the science of chiropractic dates back to the earliest days of civilization, making appearances in texts discovered from ancient Chinese and Greek civilizations. Today, chiropractic care ranks as the third largest health profession, surpassed only by medicine and dentistry. Here’s how chiropractic works and how it can help you.
With 77,000 chiropractors practicing across the country, this rapidly expanding field offers thousands of patients hope for pain relief. Increasing numbers of everyday people are turning to this time-honored tradition, the same one used by every team in the National Football League to help its players recuperate from whiplash, muscles strains, and neck and low back pain, according to the American Chiropractic Association (ACA).
But, chiropractic care itself has existed since ancient times. Too many ignore these historic, effective traditions as fancy treatments and pharmaceutical interventions captured the public imagination over the past century.
Writings dating from 2700 B.C. and 1500 B.C. were uncovered in Greece and China that reference the use of chiropractic care. Later, Hippocrates, the famous Greek physician whose eponymous Hippocratic Oath all doctors take, famously wrote:
“Get knowledge of the spine, for this is the requisite for many diseases.”
Starting in the late 1800s, chiropractic care emerged in the U.S., pioneered by an Iowa doctor named Daniel David Palmer. Palmer founded the Palmer School of Chiropractic. This school lives on to today, steeping young doctors in the rich traditions of the practice.
During chiropractic school, students undergo four to five years of training. They spend at least 4,200 hours spent in the laboratory, classroom, and medical clinic. Before practicing, chiropractic doctors must pass a national board test along with any tests required on the state level. Each state also has its own licensing requirements. The depth and breadth of training confers chiropractors the ability to act as primary care providers, according to ACA.
Today, the harsh effects of harmful drugs and the reality that wellness comes from a healthy skeleton and lifestyle—not costly and dangerous drugs—is again taking hold. With it, the momentum builds for more natural, holistic, and effective treatments.
Chiropractors focus on the health and proper alignment of the musculoskeletal system. Many muscle and joint pains result when some component in this intricate system of muscles, joints, bones, tendons, and ligaments falls out of place. Whether you’re a sports star or desk jockey, anybody’s musculoskeletal system may experience a disturbance resulting from daily activity.
Chiropractic medicine is based on the idea that a person’s overall health is linked to spinal alignment. The spine is not just a column of bones. It also houses the central nervous system. And, this affects the way a person processes pain.
All body parts are intricately connected. A misalignment in one area can influence misalignments, or even pain, in other, seemingly non-related parts of the body. Through spinal adjustments and manipulations, chiropractors help patients ensure their bodies are in optimal alignment, which encourages the free flow of muscles and bones. Without restriction in the musculoskeletal system, most patients experience a reduction in pain.
The chiropractic approach is medicine-free, minimally invasive, and holistic. The most common techniques used are spinal adjustments or manipulations, but chiropractors treat the whole person. They examine lifestyle choices like diet, stress, sleep, and physical activity levels. These factors influence a person’s experience of pain and the degree of healing that’s possible.
A spinal manipulation may reduce a patient’s pain, but helping that patient possibly lose weight or reduce stress, for example, will support continued health.
Studies show that patients who actively participate in their treatment experience better outcomes and reduced pain. Many patients with low back pain find chiropractic care is an effective way to manage discomfort and find improved quality of life.
Another benefit is that the practice is minimally invasive. Injured workers are 28% less to undergo spinal surgery if they visit a chiropractor before an MD, ACA reports.
With prescription drug abuse skyrocketing and the dangers of opioids increasingly well known, more patients are gravitating toward chiropractors and their minimally invasive, effective methods of treatment.
Back pain is a pervasive and serious issue, affecting up to 80% of people at some time during their lives, according to the ACA. At any given time, about 31 million U.S. adults experience back pain.
While back pain has many lifestyle risk factors, such as poor posture and sedentary living, studies have shown that chronic back pain is related to changes in pain processing, according to research published in The Journal of Pain. The study found that patients receiving spinal manipulation therapy experienced less sensitivity to pain, and researchers said the procedure holds promise as a clinical treatment.
Another study published in The Spine Journal examined the benefits of spinal manipulation in patients with acute back pain and found the chiropractic technique outperformed other treatment methods like medication or exercise.
Back pain is one of the leading causes of disability and costs associated with treating it are estimated at $194 billion annually, according to the American Academy of Orthopaedic Surgeons. Studies show that chiropractors can alleviate some of that cost burden, with patients spending up to 20% less when they visit a chiropractor first instead of an MD, according to ACA.
Chiropractors, instead of prescribing drugs or invasive procedures, seek to understand pain conditions from musculoskeletal origins.
Often times, pain results from tissue injuries that lead to hypermobile or restricted joints. Injuries sometimes develop from accidents, but may also result from daily repetitive stress, such as poor posture.
When tissues become injured, they become inflamed and painful, limiting muscle and joint mobility and often causing seemingly unrelated pain.
Chiropractors are able to uncover the musculoskeletal issues underlying many painful conditions and perform the necessary adjustments. In addition to approaching pain from this alignment perspective, chiropractors also frequently suggest rehabilitation techniques and lifestyle changes such as diet, exercise, and stress management to support a path to healing.
Chiropractors use a whole-body approach with patients. The doctors are trained in specific diagnostic techniques that range from skeletal imaging to observing how patients’ bodies move to identify areas needing adjustment.
During a chiropractor appointment, patients may undergo an examination, receive hands-on treatment to correct misalignments, or receive information about possible lifestyle modifications to help reduce pain.
The short answer is yes, but let’s dive a little deeper.
First, one of the most commonly used methods of treating back and other types of musculoskeletal pain is painkillers. However, even over-the-counter medications like Advil and Tylenol are not without danger when taken over long periods of time.
These medicines are intended for short-term issues, like healing a headache or acute injury. When taken continually, these medications may cause gastrointestinal problems such as ulcers or bleeding. Other risks include high blood pressure, kidney problems, or even heart issues.
With many medical treatments emphasizing invasive methods, chiropractic care offers a refreshingly non-invasive approach. And even among non-invasive therapies, chiropractic care ranks among the safest there is.
No treatment is 100% safe, and there are risks, however those risks are very small. Some patients experience feelings of soreness or achiness following treatment, but that discomfort usually disappears within 24 hours.
Some claims have linked a specific type of neck manipulation with a stroke known as vertebral artery dissection. However more complete evidence suggests that this stroke may take place spontaneously, and chiropractic care is not a trigger.
Other reports have connected the stroke to normal activities like turning the head while driving or even getting shampooed in a hair salon. These patients have specific symptoms involving neck pain and a headache for which they seek treatment. Only one in 5.85 million patients will experience this type of stroke connected to a high-velocity upper neck manipulation, making this an extremely rare occurrence.
Patient satisfaction for chiropractors is extremely high, with low-back pain patients giving the doctors high marks, above even physical therapists, surgeons, or primary care physicians.
Chiropractors believe in conservative care first. They believe that non-invasive treatments should come before more drastic measures. Further, medications should be used sparingly, and not as the first line of defense. As the American Chiropractic Association (ACA) says:
“For years, many patients would find relief through conservative forms of care such as chiropractic services only after unsuccessfully trying a range of other, more complex, and riskier treatments. Today, that approach has been reversed.”
Chiropractic care promotes non-invasive, drug-free treatments when possible to support patient health.
Over the past few years, increasing awareness about the dangers associated with opioid drugs, which are frequently used to treat back pain, has led to a resurging interest in methods such as chiropractic and associated treatments, including acupuncture.
Opioids are dangerous because they can lead to addiction, and even overdose or death. Meanwhile, these powerful drugs don’t address pain’s root cause. Instead, they leave patients reliant on these pills, which aren’t 100% effective, for the rest of their lives. As these ill effects become better known, alternative therapies such as chiropractic are growing more popular.
Chiropractic doctors focus on the body’s musculoskeletal and nervous systems. These specially trained physicians perform treatments including spinal manipulations, also known as adjustments. These work to increase mobility of a patient’s spinal vertebrae and ensure they’re in the proper alignment.
Do you suffer from pain in your shoulders? Finding out the shoulder pain causes that are affecting you can be the first step towards treatment. Here are the
Shoulder pain originates in the shoulder joint, which includes the collarbone, shoulder blade, humerus, and the four groups of muscles within it. The shoulder has a huge range of motion. It’s is one of the largest joints in the human body, which also makes it one of the most vulnerable to pain. Here are the five most common shoulder pain causes, along with treatments you can use to find relief.
Shoulder pain can come in a variety of different forms and can occur for a myriad of reasons. This includes simple overexertion, fractures, arthritis, and even infections or tumors. The most common symptoms include:
If you’re from pain, there’s a number of shoulder pain causes that could be contributing to it. Some types of pain have an obvious origin–an injury or overexertion during exercise. For others, the cause may not be so apparent. For example, it could be due to an underlying chronic pain condition. Others may suffer from repetitive stressors in their environment. Something as simple as using your computer mouse everyday in an incorrect way could actually lead to pain.
Nevertheless, there are a few more common causes of pain. These include:
The rotator cuff is the group of four muscles that inhabit the shoulder. They are help stabilize the shoulder and assist in its movement. It is also one of the most common spots for injury, although the rotator cuff can be damaged for months or years before symptoms start to surface. Common symptoms include limited range of motion, difficulty sleeping due to shoulder pain, tenderness when reaching up, and pain in the shoulder especially at night.
There are three main categories of rotator cuff injuries:
Bursitis is caused by inflammation of the bursa, which are fluid-filled sacs that help the shoulder move and typically occurs after an injury
Tendinitis is an injury caused by overuse of the shoulder muscles, which causes them to become inflamed
Finally, there are tears in the shoulder that can be caused by untreated tendinitis or an acute injury
As familydoctor explains, you’ll know when the rotator cuff is hurt if:
“If the rotator cuff is involved, the pain is usually in the front or outside of the shoulder. This pain is usually worse when you raise your arm or lift something above your head. The pain can be bad enough to keep you from doing even the simplest tasks. Pain at night is common, and it may be bad enough to wake you.”
Treatment for a rotary cuff injury depends on the severity of the damage done and which category it falls into. Over 50% of injuries can be fixed using specific exercises and various at-home care options. However, in the worst-case scenario, surgery will be required to fix the tear as range of motion and shoulder strength will not improve without it.
Osteoarthritis (OA) is a disease of aging that is the most common type of arthritis. It is the leading cause of disability in adults in the U.S. In fact, over 1/3rd of adults over the age of 65 suffer from this disorder.
Osteoarthritis occurs in the shoulder when the cartilage that covers the joint starts to break down, although it can occur in any joint. With the breakdown of this protective layer, there comes an increase of friction as the bones of the socket have more direct contact, which can lead to bone damage. Many people experience pain, swelling, stiffness, and a limited range of motion due to this shoulder pain condition.
The treatment for this condition is highly dependent on the person. Some can manage their symptoms with exercise, physical therapy, and medication. Others, however, may require more drastic care in the form of surgery. The surgical treatment can range from cleaning damaged tissue to replacing the joint all together.
Adhesive capsulitis, also known as frozen shoulder, is a condition that limits the range of motion in the shoulder. It typically occurs when the tissue in the shoulder thickens and scars, which leaves little space for the joint to rotate properly. The risk of developing this condition increases if you are recovering from other medical conditions that prevent movement of the arms. Signs of this disorder usually start gradually and worsen over time. The symptoms for this condition are swelling, pain, and stiffness.
Frozen shoulder is a condition that becomes worse the less you use your shoulder. While this disorder can go untreated, it can take as long as three years for it to heal naturally. Standard treatment will speed the healing process up tremendously. Treatment includes physical therapy and medications. Physicians will often try interventional procedures such as steroid injections, joint distension, and shoulder manipulation as well. If none of these work, generally surgery is the only other viable option.
You can watch a steroid injection in the following video. This procedure was done on the lower back, but the principles are similar.
Dislocation is another severe cause of shoulder pain that can occur from a forceful impact or fall. When a shoulder is dislocated, the humerus bone is jarred loose from the socket, which can tear ligaments and tendons. This event is extremely painful and you should seek medical attention if it occurs as soon as possible. Improper care can lead to nerve damage and once you dislocate a shoulder, it is much more likely that it could happen again.
Treatment involves a medical professional putting the dislocated shoulder back into the socket, which is called reduction. Afterwards, a standard RICE procedure is recommended and a physician will likely immobilize the arm in a sling for several weeks and prescribe rehabilitation exercise. If shoulder dislocation becomes a chronic condition, surgery might be required to repair the ligaments.
Thoracic outlet syndrome is a group of disorders that develop when the blood vessels or nerves in the thoracic outlet become compressed. This outlet is a small space that is located between the collarbone and the first rib. This typically causes pain in the shoulders and neck along with some numbness in the fingers, and discoloration in the extremities due to inadequate blood flow. These symptoms can worsen when the arm is placed above the shoulders or fully extended.
The exact cause of thoracic outlet syndrome is not always known, but certain conditions can trigger its development it. These include muscle enlargement due to weightlifting, repetitive movement or injuries, severe impacts such as from car accidents, weight gain, and pregnancy.
The treatment for this disorder consists of physical therapy and medication. Doctors will also recommend that you make certain lifestyle changes as well. These can be frequent stretching, avoiding carrying heavy objects, and strengthening the muscles around your thoracic outlet. If none of these approaches work, a doctor will likely recommend surgery.
Click each of the links above to learn more about these conditions. Each page discusses symptoms of these conditions, as well as potential treatments for relief.
If you suffer from pain in your shoulders, there are treatment that can help. Further, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) reports that they’re actively looking for better treatments for pain in the shoulder. They note that they’re studying ways to:
Correct movement patterns that cause shoulder pain in some people with spinal cord damage
Develop new medicines that help muscles and tendons heal
Prevent and treat rotator cuff tears
Organizations and healthcare professionals working every day to find better options for patients. Overall, though, the most important thing is to get a diagnosis for your condition. That way you can ensure you’re applying the right treatments to your condition, for the most effective results. A pain specialist can help determine what’s causing your pain and lay out a few treatment options that could work for you.
Notoriously difficult to diagnose, fibromyalgia causes very real pain to those affected by it despite remaining a mystery in many other ways. A musculoskeletal disorder, it’s characterized by a lowered pain threshold and extra sensitivity to situations that would cause an unaffected person no pain at all. Fibromyalgia research is constantly looking for emerging therapies that could help a patient reduce their pain. Here’s three of the latest.
Although fibromyalgia affects roughly 2 to 4 percent of the U.S. population (about 9.5 million people), its exact cause remains unknown. Maybe a single cause is so hard to pin down because the development of fibromyalgia has been linked to a number of different factors, some combination of which could be the culprit.
For example, a genetic mutation might make someone more likely to develop the disorder, while others argue that fibromyalgia can be triggered by an infection or sickness. And some experts link the onset of the disorder to physical or emotional trauma, as patients who present with fibromyalgia have often also been diagnosed with anxiety, depression, or post-traumatic stress disorder.
One thing’s for sure: Fibromyalgia affects more women than men, with nine women diagnosed for every one man. This may be a result of certain reproductive hormones present in women, but nothing can be decisively said as to why women are at a higher risk than men.
The cause may be unclear, but the pain is easier to explain. Once the condition presents itself, fibromyalgia pain results from an unusually high amount of certain chemicals in the brain that are responsible for triggering pain signals. This is also called a neurochemical imbalance.
At the same time, although we don’t completely understand why, pain receptors in the brain become extra sensitive to pain, causing contact that would otherwise not be uncomfortable to be very painful for a person suffering from fibromyalgia.
These pain symptoms can be accompanied by a range of other problems, including:
Irritability
Trouble falling asleep or staying asleep
Difficulty remembering things, also called fibro fog
Unfortunately, there is no chemical test available to directly confirm a person is afflicted with fibromyalgia. Instead, a doctor must use a number of other methods to make a diagnosis.
Initially the doctor will observe the patient’s pain symptoms. According to the American College of Rheumatology, fibromyalgia is characterized by widespread pain endured for a minimum of three months. The term “widespread” means the pain should be present on both sides of the body as well as on both the upper and lower body.
The ACR also describes fibromyalgia as tenderness or pain felt at specific places on the body, including the shoulders, the upper chest, the elbows, the hips and the knees. There are a total of 18 of these specific points listed by the ACR, and a person must experience pain in at least 11 of these for the condition to be considered fibromyalgia.
But the surest way a doctor can determine a patient suffers from fibromyalgia is actually to rule out every other possible condition — a process which can be involved and lengthy. Patients shouldn’t be discouraged at the sometimes long process, however, as it means the doctors and medical staff are being as thorough as possible.
Treatment plans for fibromyalgia can be complex. Since there’s no cure for the condition itself, treatment must instead focus on the symptoms, on any coexisting conditions, and on any underlying medical problems that could have triggered or aggravated the fibromyalgia in the first place. We’ll discuss some of these more common treatment plans, before discussing the emerging treatments that fibromyalgia research is focusing on.
Over-the-counter pain relievers, such as acetaminophen, or non-steroidal anti-inflammatory drugs (nsaids) like ibuprofen or naproxen might be recommended to alleviate some discomfort, or the doctor may prescribe something a little stronger, for example, tramadol. In some cases, anti-seizure drugs can be prescribed to effectively reduce fibromyalgia pain symptoms.
The combination of medications a doctor prescribes will ultimately depend on the patient’s exact symptoms, since these are rarely identical from patient to patient. Every person’s case is unique, with different triggers, different levels of pain, and different conditions or symptoms occurring simultaneously. For example, an antidepressant might also be necessary to fight lethargy, or a relaxant may be required to initiate sleep.
Limiting intake of caffeine, nicotine and other stimulants
Due to fear of their symptoms and the associated pain and discomfort, people who suffer from fibromyalgia can be inclined to withdraw from society and become inactive. Doctors recommend against this, however, as those patients who remain as active as possible — without overdoing it — on a consistent basis, seem to have the best success with managing their symptoms and leading normal lives.
Many people also benefit from therapy sessions, in which they can not only discuss with a professional counselor the impact fibromyalgia has had on their lives, but also explore strategies for overall stress reduction on a day-to-day basis. This type of training can be crucial for giving patients the confidence to keep living their lives to the fullest potential, without the concern of being limited by their condition.
Fibromyalgia frequently doesn’t respond well to traditional medications, but the good news is that many people find alternative remedies helpful. Therapies like oxygen chamber therapy, low-level laser therapy, and transdermal magnesium are hitting the market, giving fibromyalgia patients new options for managing pain and improving quality of life.
Oxygen chamber therapy in particular has researchers making grand promises—promises not just of pain relief, but of the possibility to reverse fibromyalgia. The treatment is still early in the study stage. However, researchers understand more about fibromyalgia every day, and this increasingly deep knowledge could one day result in a cure.
This treatment, which involves breathing in pure oxygen from a tube or while sitting in a pressurized room—hence the term “chamber”—has shown promise for helping people with fibromyalgia.
Officially known as hyperbaric oxygen therapy, the treatment been used for some time to help scuba divers heal from decompression sickness, which is when gasses in the blood form bubbles as divers move toward low pressure. The treatment also works for slow-healing wounds related to diabetes or serious infections, according to Mayo Clinic.
Research from Rice University has also found the treatment offers hope for fibromyalgia patients. Scientists evaluated 48 women with fibromyalgia who underwent oxygen chamber therapy for two months and found that 100% of them experienced some form of benefit.
An increasing body of clinical evidence shows that fibromyalgia develops from abnormalities in the nervous system and brain pathways, many of them related to pain processing. Rice researchers found that hyperbaric oxygen therapy enhanced functioning in these faulty areas.
Fibromyalgia affects about five million people, most of them women. Researcher Eshel Ben-Jacob says:
“Symptoms for about 70% of the women who took part have to do with the interpretation of pain in their brains… They’re the ones who showed the most improvement with hyperbaric oxygen treatment. We found significant changes in their brain activity.”
In the study, participants underwent 40 treatments, each lasting 90 minutes, for five days each week over the course of two months. During treatment sessions, patients breathe in oxygen that’s pressurized three times higher than normal air. The highly pressurized nature allows lungs to absorb greater quantities of oxygen, which then gets absorbed systemically by the body.
Fibromyalgia patients receiving oxygen chamber therapy also experienced a dramatic reduction in pain. The body thrives off this pure oxygen and is better able to heal, fight off bacteria, or in the case of fibromyalgia patients, process pain. Many patients who participated in the study were able to decrease the amount of medications they were taking or, in some cases, stop taking pills all together.
Researchers said oxygen chamber therapy actually reversed fibromyalgia, targeting the condition’s source, while all the pills did was ease pain, and not heal the underlying condition. Researcher Shai Efrati says:
“The results are of significant importance since, unlike the current treatments offered for fibromyalgia patients, (oxygen chamber therapy) is not aiming for just symptomatic improvement…(It’s) aiming for the actual cause—the brain pathology responsible for the syndrome. It means that brain repair, including even neuronal regeneration, is possible even for chronic, long-lasting pain syndromes, and we can and should aim for that in any future treatment development.”
These promises aren’t as grandiose as they may seem: Efrati says 70% of the research participants no longer had diagnosable criteria for fibromyalgia at the end of the study.
Oxygen chamber therapy currently has federal approval for use in 14 conditions, including serious infections and burns, but not yet for fibromyalgia, according to webmd.
Unfortunately, until future studies prove the benefit on a wide scale and the Food and Drug Administration (FDA) approves the treatment, insurance plans won’t cover the treatments, which can cost tens of thousands of dollars because so many are needed.
We’ll be sure to keep you up to date as this exciting area of fibromyalgia research develops.
With laser therapy, lasers shoot through soft tissue, and the light of the beam raises the temperature. Data is so far mixed on whether the technology works, but fibromyalgia research does show benefits that are promising. Scientists aren’t sure how the treatment works, but are working to learn more.
One possible theory that explains how low-level light laser therapy works involves a process known as photo bio stimulation. This idea holds that when the energy of the laser penetrates the tissue, it creates adenosine tri-phosphate (ATP), which helps produce cellular energy.
Enhanced delivery of life-supporting materials like water, oxygen, and other nutrients
Research results for this therapy have been mixed, but several have shown promise. More research is needed to better quantify the potential for this therapy to treat pain from fibromyalgia.
Other names for low-level laser therapy are cold laser therapy, low-energy laser therapy, low-intensity laser, and monochromatic infrared light energy (MIRE) therapy.
Magnesium is an important nutrient for optimal body functioning, however many people don’t ingest enough of mineral. Fibromyalgia, chronic fatigue, and anxiety may all be symptoms of a deficiency.
People often take magnesium in pill form, but transdermal magnesium involves applying magnesium directly to the skin. One way of doing this involves rubbing oil directly on the skin, where it can easily be absorbed and distributed throughout the entire body. Another option is to take a bath with Epsom salt, which is magnesium sulfate.
Gels and patches are also available, however rubbing oil on the body and taking baths have relaxation and other therapeutic benefits, and are wonderful ways to receive healthy amounts of magnesium.
Only a few small trials of fibromyalgia research have found transdermal magnesium has a large benefit, but the anecdotal evidence is vast. Plus, with magnesium deficiencies so common, transdermal magnesium is a good health practice to have.
While fibromyalgia research continues to pave the way for new and innovative treatments, patients should first make sure they have an accurate diagnosis. You can work closely with a pain doctor to find out if you have fibromyalgia. They can also help you learn more about complementary and advanced treatments for reducing your pain.
Shoulder pain at night is a very common issue among chronicpain sufferers. The shoulder is one of the most vulnerable joints as it has such a wide range of motion, which opens it up to various injuries and problems. So, why are you experiencing shoulder pain at night and what can you do to find relief? We discuss five treatment options ranging from shoulder stretches to chiropractic to interventional procedures.
On top of the pain, most people with shoulder pain at night sleep poorly, which a completely different set of problems has associated with it. These can include:
Although many shoulder disorders can cause pain, the most common cause of shoulder pain at night comes from rotator cuff tendinitis. It usually is caused by irritation of the shoulder tendons leading to inflammation and pain. This condition can be caused by many things, including:
During the day, the shoulder is being actively used while you are in a vertical position. The tendons engage and are pulled downward by gravity, which allows space to be made in the muscle groups in the shoulder. This additional space allows for an increase in blood flow and oxygen that alleviates the stiffness and pain that would be present otherwise.
When you lay down to rest or sleep at night, you are generally in a horizontal position. This removes the effect of gravity and allows the shoulder muscles to relax. The lack of movement and the relaxation of the muscles allows the fluids in your joints to settle and decreases the flow of blood, allowing the joint to become inflamed. People also tend to lie on their shoulder while sleeping, which can compress the joint even further, and thereby worsening the inflammation.
The first course of action to relieve shoulder pain at night is to find a good sleeping position for you. Tossing and turning at night is normal for most people, but can agitate your shoulder if you land on it wrong. Sleeping on the opposite shoulder can help avoid this pain, but try not to sleep on your back.
If the pain persists, you can always trying wrapping your arm or wearing a sling to assist in preventing movement during sleep. Sleeping with a pillow under your knees can help alleviate any associated back pain.
Along with fixing your position while sleeping, always make sure to try to stick to a sleeping schedule. Good sleep hygiene can make all the difference in your sleeping patterns. Having a consistent bedtime ritual that helps wind you down at the end of the day can do wonders in terms of reducing stress and tension, and improving sleep length and quality.
Try something relaxing before bed like a shower and make sure you fall asleep in a dark room with no electronics. Medication can also help you sleep, but be cautious of how often you use them. Constantly requiring sleep aids can be a major sign of a problem and the more you use over-the-counter drugs, the more you will need to be effective. In addition, if you’re using other medications, they may react poorly with the sleep aids.
Exercising a few hours before bed can also be useful as it will increase blood flow throughout the whole body. This can alleviate pain, but also relax you enough to ease sleeping troubles. Try something low impact like a brisk walk or a bike ride, and then allow your body to cool down again before going to bed.
Further, certain shoulder stretches can help you reduce the tension and stress that has built up during the day. Not only are shoulder stretches an easy option, but they take only a few minutes at night. Stretching has huge health benefits like increasing flexibility, range of motion, and blood flow. Another big plus is that they are simple to do in your own home and require no special equipment. Before you go to bed, try these seven shoulder stretches to alleviate some tension and reduce your stress.
If you start to feel pain at any time during a stretch, stop immediately. Stretching should be done to the point of mild strain. If you experience pain, you are going too hard and could injure yourself. This is especially true if the pain is sharp or sudden. It is a good idea for chronic pain sufferers to consult a pain doctor before starting too strenuous of a stretching routine as overexertion could exacerbate certain conditions.
For best results, always warm your muscles up a little before stretching. For the following stretches, it is best to do each for approximately 30 seconds to one minute for maximum effect. Also, make sure you are steadily breathing in and out in a controlled manner.
This is a quick stretch that is great if you spend way too much time staring at a computer monitor. Slowly extend your neck outward, making sure your keep your chin parallel with the floor. Then, pull it back in to a neutral position that is straight with your spine, slightly tucking the chin in. Repeat.
Sit in a cross-legged position on the ground. Extend your arms in front of you and place your left elbow in the crook of the right arm. Now, bend your elbows back so your hands are touching. Hook one hand over the other so that your palms are facing each other.
For this stretch, you should keep your palms together, elbows lifted in a 90 degree angle, and your hands in front of your face. Try to keep your shoulders relaxed and down. You should feel a powerful stretch in your shoulder blades as well as the lower part of your neck. After this, change arms by placing your right elbow in the crook of your left arm and repeating.
Take your right arm and reach over your shoulder aiming to lay your palm in-between your shoulder blades. Then take your left arm and reach up your back (not over the shoulder) also placing the hand between the shoulder blades. Try to interlock your hands and pull slightly.
If you are having trouble interlocking your hands, you can modify this stretch. Keep a towel or something similar in your top hand, and then grasp it with your bottom hand instead of clasping the hands together. Gently pull with each arm to feel your shoulders start to open up.
While standing tall, reach out and place both of your hands on a wall. Walk your feet back until the arms are straight, but don’t let your arms reach too far above your head. Make sure you keep the shoulder blades open and relaxed downwards during the whole stretch. Also, avoid pushing against the wall and don’t allow your shoulders to press up and into your neck.
Start by spreading your feet, so they are shoulder-width apart. Raise your arms above your head as far as possible and bring your palms together. Now, simply twist your waist by bringing one shoulder forward and simultaneously pulling the opposite shoulder back. Hold this stretch and then switch sides.
This stretch begins by lying face down on your stomach. First, place your right hand palm down on the floor like you are starting a pushup. Next, lift your chest slightly and slide your left arm under your chest. Finally, square your chest with the floor and lower on top of your arm. Hold this position and then switch your arms.
If you want a deeper stretch in this position, you can move on to the full dragonfly. This is accomplished by lying on your stomach face-down. Crisscross both arms near the collar bones and straighten your arms out as far as possible. Then, allow your body to drape onto your arms.
Stand your feet hip-width apart. Turn your right foot forward. Turn the left foot so it is perpendicular with the right and raise both arms to shoulder level straight out from the body. Stretch your right arm up and forward, pulling your body up slightly. Then slowly lower the chest forward over the right leg until it is parallel with the ground. Place your hand on your thigh or calf, while avoiding placing it on the knee directly. Try to keep as little weight in your hand as possible, focusing on keeping yourself upright with your core instead. Extend the left arm completely upward towards the ceiling, if it feels comfortable. Finally, turn your head upwards towards the ceiling or down towards the ground for an additional neck stretch.
Since shoulder pain at night is often related to neck pain, trying the following yoga poses for neck pain could also help relieve your pain. This video also demonstrates the triangle shoulder stretch.
If these natural treatments don’t work to relieve your shoulder pain at night, it may be time to talk to a pain doctor. They can help diagnose the exact cause of your shoulder pain. If your pain isn’t due to an acute injury or fracture, they may suggest interventional treatments for chronic pain.
These shoulder pain at night treatments include:
Physical therapy to increase flexibility and reduce pressure on your joint
Chiropractic care to increase mobility and loosen tension
A regimen of non-steroidal anti-inflammatory medications
Joint injections that can relieve nerve irritation
Surgery, but only for the most severe cases of shoulder pain at night
If more conservative treatments like chiropractic care or physical therapy haven’t worked, a joint injection provides a minimally-invasive treatment that doesn’t require surgery. You can learn more about this approach in the following video (while not a shoulder injection, it does showcase a knee joint injection using a similar approach).
In the fight against lower back pain, many people and their doctors reach for the same weapons: common over-the-counter (OTC) and prescription medications. New research on commonly recommended and prescribed lower back pain medications has found that many may actually be virtually ineffective for treating lower back pain and that medication for lower back pain may actually do more harm than good.
Nsaids are a standard go-to medication for lower back pain, but their effectiveness is being called into question. The common over-the-counter pain medications Tylenol, Advil, and Aleve are all types of nsaids. More powerful nsaids are also available by prescription from your physician. For many people with chronic back pain, it’s not unusual to keep a bottle of over-the-counter nsaids on hand to treat pain as needed.
A great many medications fall into the classification of nsaids, but all of them function in a similar way. Nsaids block an enzyme called cyclooxygenase (COX), which in turn inhibits the production of certain inflammatory responses like fever, swelling, and pain. Since many instances of pain are caused by inflammation or swelling, inhibiting inflammatory responses should reduce pain.
However, COX enzymes also aid in protecting the stomach lining, which is why using nsaids can sometimes lead to ulcers or bleeding in the stomach. Potential side effects of nsaids include digestive symptoms like heartburn, diarrhea, vomiting, or stomach pain.
Tylenol in particular has been widely advertised all over the world as a catch-all OTC medication for aches and pains of every variety. From acute back pain to achy knees and chronic pain, advertisements would have you believe that Tylenol is effective and safe for pain. A study from theBMJ(formerly the British Medical Journal) found that Tylenol’s claims of efficacy in the treatment of both back and knee pain were false.
A meta-analysis of randomized controlled studies focusing on Tylenol’s ability to relieve spinal pain and pain due to osteoarthritis found that for spinal pain, Tylenol showed no effect on pain in either short- or intermediate-term follow-ups. For osteoarthritis, the short-term efficacy of Tylenol for spinal pain was more pronounced than for intermediate use, but pain reduction was still rated as moderate. Any pain relief reported was clinically insignificant and similar to the placebo group. The studies included in the meta-analysis focused on just over 5,300 patients with lower back pain and knee pain and excluded any patients with previous surgeries for either condition.
While some patients suffering from chronic and acute back pain may find that any minor reduction in pain is worth the risk, the side effects may not be worth it. Since 2011, the Food & Drug Administration has required medications that use acetaminophen to carry a “black box” warning that highlights its risk for liver failure.
Many who take Tylenol for pain do not realize that other medications (e.g. Cold medicines) also contain acetaminophen. Exceeding the maximum daily dose by even a small amount can cause serious side effects and may even cause death. For anything other than acute, short-term pain, taking Tylenol is not recommended as a medication for lower back pain.
Opioids are a narcotic pain reliever. Previously used primarily for short-term relief of acute pain, or for pain relief in patients with a chronic condition like cancer, opioids have become part of mainstream pain management over the last two decades. The number of prescriptions written for oral opioid medications, such as hydrocodone, oxycodone, or hydromorphone, has more than tripled over the last 20 years. Despite the risks associated with opioid medications, they are becoming increasingly widespread as a prescribed medication for lower back pain, even though new research suggests opioids aren’t very effective for this type of pain.
While the risks of opioids have been well-documented, a study by the American Academy of Pediatrics found that the use of prescription opioids is linked to fewer positive outcomes after spinal surgery. The study of just over 500 patients used patient reporting to measure health preoperatively and at three, six, and 12 months post-operatively. Differences in recovery, mental health, and decreased pain was significantly influenced by opioid use in the following ways:
Patients who increased opioid use before spinal surgery did significantly worse post-operatively at three and 12 months
For every ten milligrams of increase in opioid use, the study found a significant decrease in mental and physical health scores
Patients who also suffered from comorbid conditions such as depression and anxiety were more likely to take opioids
Lead study author Clinton J. Devin, MD, assistant professor of orthopedic surgery and neurosurgery at the Vanderbilt Spine Center had this to say about the treatment implications of study’s findings:
“Our work highlights the importance of careful preoperative counseling with patients on high doses of preoperative opioids, pointing out the potential impact on long term outcome and working toward narcotic reduction prior to undergoing surgery.”
Even for those patients who choose not to undergo surgery, opioids have very little effect on chronic low back pain. While there seems to be some short-term analgesic benefit, the risk of dependence and other side effects likely outweighs the minimal benefit in intermediate- and long-term use for this medication for lower back pain.
Researchers have also been reevaluating the trials and evidence that support the effectiveness of opioid pain medications, and the evidence doesn’t hold up. The National Institutes of Health (NIH) convened a seven-member panel to examine the evidence for opioid medications. An article by the University of Connecticut summed up the results, noting:
“A National Institutes of Health white paper that was released today finds little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs.”
Additionally, a University of Colorado Boulder study showed that opioid use (specifically morphine) actually prolonged neuropathic pain in rats, suggesting that it could have the same effect on humans.
Finally, the BMJ published a clinical review of the efficacy of opioids as a medication for lower back pain. The conclusions in this article include:
Opioids don’t speed injured workers’ return to work
Opioids don’t improve functional outcomes of acute back pain in primary care
There is little evidence of opioid efficacy for chronic back pain
It was also pointed out that controlled trials of opioids for back pain tend to experience a high dropout rate among participants. The trials also have a short duration (generally four months or less) and have highly selected patients. This all suggests that the controlled trials that do support opioid efficacy for back pain are perhaps not reliable, or at least are not thorough enough.
Opioids also have a high risk of abuse and dependence. Using opioids before spinal surgery has been linked to a higher risk of negative surgical outcome. Slow-acting opioids, which have been assumed to be safer than fast-acting opioids, have been shown to make men five times as likely to develop low testosterone. More and more evidence continues to point to the fact that opioids are not a suitable medication for lower back pain, unless used for highly-controlled, acute cases.
Steroids are commonly used to treat inflammation associated with back pain, but they may not be as effective as previously believed. Steroids, also called corticosteroids, are a synthetic (man-made) version of a hormone naturally found in the body. Steroids are used to treat many different conditions, largely because they are cost-effective and can be applied in many different forms (oral, injected, inhaled, topically, etc.). Long-term or illicit use of steroids is associated with several potentially-serious side effects, but when used as directed, steroids are generally considered safe.
In a randomized controlled trial of 267 people with herniated disc, researchers found that there was no significant difference in pain relief between the group receiving oral steroids (prednisone) and the group receiving a placebo. Both groups saw improvement, but even after a year, there was no difference between the two (except in rate of disability, which was slightly lower in the prednisone group).
Likewise, a study originally published in the Journal of the American Medical Association (JAMA) looked at the efficacy of the oral steroid prednisone in treating sciatica-related back pain. In this study, half the participants were given a 15-day course of prednisone to treat sciatica resulting from a herniated disc, while the other half were given placebos to treat the same condition. Although both groups’ symptoms improved, there were no statistically significant differences in pain or disability by the end of six weeks.
Again, this is a case of the side effects outweighing the negligible benefits. In addition to headache, mood swings, and irregular heartbeat, long-term use of prednisone is a risk factor for osteoporosis, which may increase the risk of spinal injury leading to pain. Steroid injections, on the other hand, provide a targeted approach to using these medications which may work more powerfully for lower back pain patients.
Even with this research, this does not mean that you should stop your medication for lower back pain, especially if they’ve been prescribed by a physician.
If you’re taking a medication that relieves your symptoms of back pain, that’s great. Keep taking it. If your current medication doesn’t seem to be doing the job, keep taking it until you’re able to talk to your pain doctor and get an alternative medication or treatment (or are given the go-ahead to stop taking it). Stopping a medication prescribed by your doctor could be unsafe if you haven’t discussed it with them before.
And keep in mind that pursuing alternative, complementary, or interventional pain management techniques – either in conjunction with or (with your physician’s permission) instead of medication – might help you control your pain much more effectively than medication for lower back pain alone.
Staying physically active is an important treatment option for lower back pain. While it may seem counterintuitive to move when you are in pain, keeping your muscles strong and engaged can be the key to a healthy back. Focus on stretches and core work, but don’t forget low-impact cardiovascular exercise such as biking, swimming, and hiking.
Although it may not work as quickly as medication for lower back pain, eating a healthy diet full of anti-inflammatory foods can make a tremendous difference in treating chronic back pain. Adding these foods while eliminating common inflammation-causing foods like sugar, wheat, and dairy can help you manage pain.
The more weight we carry on our bodies, the more stress there is on our joints. Maintaining a healthy weight with diet and exercise can be an important part of treatment for back pain, especially in cases where back pain is due to compression injuries such as herniated discs or inflammation caused by spinal stenosis.
Acupuncture is gaining traction as an effective treatment for low back pain. Chiropractic care can also be an excellent first-line treatment that minimizes the chance of spinal surgery in the future. Mindfulness meditation and biofeedback have both been shown to diminish the perception of pain. All of these treatments are nearly side-effect free, and many are now covered by insurance.
Finally, if your pain doesn’t respond to medication for lower back pain or these complementary approaches, you could try more targeted therapies for resolving your back pain. This will involve identifying the underlying causes of your back pain and finding a therapy that can work to resolve or treat the symptoms of your pain. Once a correct diagnosis is made, your doctor may recommend any of the following therapies:
When it comes to the topic of Fibromyalgia and exercise, there is an abundance of research showing exercise to be extremely beneficial when it comes to managing pain. However, for many with Fibromyalgia, exercise may seem completely counterproductive. After all, you really don’t need to look very far to find people who have tried to exercise but have then experienced one of the biggest pain flare-ups of their life, as a direct result of exercising.
So, why is exercise held in such high esteem, especially when there are so many people who seem to have such negative reactions to it?
Why can some people with Fibromyalgia seem to get away with exercising, yet others end up in bed for a week with a fibromyalgia flare-up?
If you are one of the many sufferers of Fibromyalgia from around the world, you’ve probably asked yourself the question “should I exercise when I have Fibromyalgia?” The available research and guidelines do say yes to this question, but is it really that simple?
In this article, let’s dive into the top of exercising with Fibromyalgia, and take a look at how people often get it wrong, and what you need to actually be focusing on when exercising with Fibromyalgia.
There is no doubt that you will have been told by friends and family that exercising can help with your Fibromyalgia. Whilst most of the time this is meant as an honest way of trying to help, nonetheless, it can often be very unsolicited advice that leaves you feeling down, as you have likely already tried exercise, all to no avail. There are reasons why people with fibromyalgia struggle with exercise, this is despite it being one of the most effective treatments for chronic pain.
But first, before we look at why people struggle with exercise, what does the research actually say about exercising with Fibromyalgia?
Research does support the idea that aerobic and strength training helps not only improve physical fitness and function, but also reduces the symptoms of fibromyalgia, whilst also improving quality of life. There are also numerous other reasons to exercise when you have fibromyalgia, such as the fact that it has largely beneficial effects on symptoms of depression, which if you are in constant pain, you will very likely have. Another study found that for those with Fibromyalgia who did take part in exercise, it significantly improved pain catastrophizing, sleep, and even anxiety.
However, not all exercise is created equal. The studies above were performed using low to moderate intensity. But, it’s important to remember, that exercise is a human construct. It’s unlikely our ancestors put aside an hour a day to exercise when their entire lives were focused on hunting and movement. Simply reframing exercise as movement, can completely change the narrative around fibromyalgia and exercise, and in some instances, actually make it enjoyable. Exercising doesn’t mean you have to go to the gym and hit the treadmill, it simply means moving.
Many people with Fibromyalgia have found this to be true when engaging in movements such as Tai Chi, a low-intensity form of self-defence. In fact, one study found that yang-style Tai Chi was one of the most effective forms of exercise when it came to Fibromyalgia, producing results fairly quickly, with very limited pushback or side effects.
Whist all of these things sound and look great on paper, it still doesn’t change the fact that there are millions of people with fibromyalgia, who end up with a flare-up from trying these exercises.
Think of it like this. We called it fibro “box”. Everyone on the planet, Fibro or not, has an exposure limit for stress. This is where the brain and body essentially put you into protection mode to keep you safe from actual or perceived, danger or damage. With Fibromyalgia, we became more sensitised to stressors: physical stressors like exercise or lack of good quality sleep, psychological stressors such as dealing with a death in the family, or social stressors such as a 40-hour work week or a global pandemic!
For those with Fibromyalgia, our exposure limit to these stressors is greatly reduced, which means that it does not take a high degree of these stressors to put us into a flare up. The important thing to keep in mind here is that when the brain senses danger, it has a brilliant little protection method to ensure that you immediately start limiting that stressor: we call this pain.
June has Fibromyalgia and currently works 39 hours per week. June starts to struggle with the work week, and often finds by the time Thursday rolls around, she is in so much pain that she is literally limping into the next work week. June has tried for 6 months now to just push through and keep working, however, one day, by the time Thursday comes, she has a huge flare-up of pain and has to call in sick on Friday. This is June going over her exposure to stress limit.
After a week, June’s pain is back down to her normal baseline and she goes back to work, unfortunately, she gets hit with another huge flare–up. June recovers and has a back-to-work meeting with her boss, where it is agreed that she can drop her hours down to 20hrs per week.
June goes back to work at reduced hours and everything is much better. After 2 weeks, June is really starting to enjoy work as it’s not so physically and mentally demanding anymore. However, as brains often do, June’s exposure limit drop and one day June goes into work and is hit with another huge pain flare-up. June rests for a week and then goes back to work, but 20hrs per week feels just like 39.
After another back-to-work meeting with her boss, June agrees to only do 10hrs per week and off she goes back to work, all whilst staying under her exposure limit.
For a little, while everything seems fine, that is until she has another huge pain flare-up. Over time as the exposure line drops more and more, June can deal with less and less stress, until eventually, she goes into the Flare-up Box.
In the box, yes she is in pain and she is still tired, but as long as she doesn’t try to push herself out of it, she will avoid any major flare-ups. This is where most people with Fibromyalgia eventually end up, conditioned and forced into the box.
Now, keep in mind, that this is not just exclusive to work, it also applies to exercise and just general mobility. Pain is a conditioning tool that absolutely works, and your brain wants nothing more than for you to be safe. So, if you’re doing exercise that your brain deems as dangerous or you are pushing past your exposure line, then you are going to slam down into that box.
The Box is a concept we came up with when we noticed a repeated cycle in many of our Fibro clients. We actually recorded a Podcast episode going into this concept in a little more depth.
The takeaway here, for those trying to exercise who have Fibromyalgia, is that exercise is a physical stressor. The amount of stress that you as an individual are able to handle at the moment, is unique to you, driven by an incredible amount of variables. Variables we will discuss in this article.
There are two reasons why exercising with fibromyalgia is so hard and difficult: Sensitisation and exposure limits. However, before we get into that, we need to look at what Fibromyalgia pain actually is. There are three main recognized definitions of pain:
Neuropathic pain: This is where there is damage to the actual nervous system. Some examples of this are nerve damage after surgery, viral infections, cancer, vascular malformations, alcoholism, neurological conditions such as multiple sclerosis and metabolic conditions such as diabetes.
Nociceptive pain: This is pain that arises as a direct result of nociception. Within your body, there are no such things as pain receptors. In fact, this outdated idea was first coined back in 1664, and keep in mind, that we were still burning people at the stake back then because we thought they were witches. Luckily, science has progressed a lot since then. We now know that what we once thought were pain receptors, are actually nociceptors.
A nociceptor is a special kind of nerve that detects anything that may be potentially dangerous, So, extremes really, of temperature, chemicals, stretch, pressure, and vibration. The job of nociceptive nerves is to report to the brain about potential danger. That’s it, they don’t tell your brain that you are in pain, they just tell your brain that something may be wrong. Once your brain has this information, it’s up to your brain to decide if producing pain is warranted or not.
Nociception and pain are two completely separate entities and they are not mutually exclusive. You can have nociception and pain, you can have nociception and no pain, and you can have pain without nociception. But when pain is created as a result of nociception, we call this nociceptive pain. An example of nociceptive pain would be stubbing your toe on a coffee table, or any injury really.
Nociplastic pain: The pain that those with Fibromyalgia experience, in general, and not just from exercises, is what we call “Nociplastic pain“. This is where there is a change in how nociception works. When pain is created, despite no clear evidence of actual or threatened tissue damage causing the activation of nociceptors or evidence for any disease, we call this nociplastic pain. Think of it as a faulty check engine light on your car, that keeps going off even though your engine is fine. This nociplastic pain is when your alarm system for danger and threat keeps going off when it shouldn’t.
So, we mentioned earlier that a reduced stressor exposure limit, is going to cause problems with how people exercise when they have fibromyalgia. But, there is also another issue that can arise to cause even more problems: sensitisation.
As we mentioned above, those with Fibromyalgia suffer from abnormalities in the way that the brain deals with pain. Supraspinal processes have a top-down enhancing effect on nociceptive processing in the brain and spinal cord. This effectively means that those with fibromyalgia may be far more sensitive to noxious stimuli compared to the general population. Brains are predictive at the end of the day, and research shows us that when a brain is unsure of the exact movement that causes pain, it will just guess. Meaning that movements that should not be inherently painful can soon become that way. Combine that with a nervous system that reports danger or a threat to tissues, when there isn’t any, and a drop in tolerance to stress, and exercising with Fibromyalgia can seem an almost impossible task.
To answer this question, we need to really understand its intent. Because as it stands, an exercise that one person can do with fibromyalgia, is often an exercise that another cant tolerate. If you are looking for a quick fix exercise to dramatically bring down your pain or push you into a full recovery/remission, then I’m sorry to say, that is not how it works. Whilst there may indeed be some form of exercise that most people with Fibromyalgia can tolerate, there are going to be people who feel worse for it.
There are many suggested forms of exercise for Fibro, which all have their own individual benefits.
As we mentioned before though, not everyone is going to have success with these forms of exercise. But, they do seem to be the most tolerated forms of exercise for those with Fibromyalgia.
Here at The Chronicillness.co, we don’t even approach the topic of exercise, until we have a good understanding of what issues our clients are facing. And when you work like this, it makes things so much easier. After all, would you rather exercise when your danger alarm system is heightened or turned down: it’s always going to be latter. We initially saw Kit online. She was practically immobile when we first met her. The slightest use of her body swung her into a flare-up for days. But, focusing on the underlying issues as to why she had Nociplastic pain in the first place, it allowed us to calm those nerves down and increase her stressor exposure limit enough to be able to start exercising and reaping the benefits. These days you can catch her at her Zumba class and hiking the hillside.
But, you’re not here to listen to us talk about our clients, you are here to learn about fibromyalgia and exercise. So let’s take a closer look at these most tolerated exercises.
We mentioned earlier that Tai Chi was one of the most effective and safest forms of exercise for Fibromyalgia. So, let’s take a closer look at why this potentially is.
Remember when we mentioned earlier that we don’t even start thinking about exercise before we find out the reasons why someone has Nociplastic pain. Well, Tai Chi is a great form of exercise because it allows people to jump straight in, without worrying all too much about the reasons why they are in pain, but still reap benefits from exercise. There have been some brilliant studies done on Tai Chi as an exercise for fibromyalgia and the benefits may surprise you.
Tai Chi is a very graceful form of exercise, it’s slow, elegant, and as far as your brain is concerned it’s a pretty low stressor. This is great for anyone with Fibromyalgia who wants to exercise, as it allows them to take part in exercise without pushing above their stressor exposure limit and causing a huge flare up. The current body of evidence shows Tai Chi to help with increased well-being and improved sleep. Something to also note is that there were no studies that found tai chi worsened a condition.
So, Tai Chi as an exercise for Fibromyalgia looks like a good way to start increasing your stressor tolerance level. If it can help to increase your well-being and improve your sleep, your pain levels will come down, which means your tolerance level to stress will go up.
One of the main forms of exercise most guidelines advocate is strength training and with very good reason. Strength training has unrivalled benefits for both chronic pain and the general population. Strength training is not just about working out your tissue, it’s also about working your nervous system. Whilst you may not see muscle growth initially, this is because neural adaptation is taking place, wherein your brain is getting better at recruiting muscle fibres.it already has. Making you feel stronger, which honestly, is a huge benefit in itself.
When you feel stronger, you hold yourself differently, you interact with people differently, and you gain a new sense of ownership over your body. When it comes to fibromyalgia, this is important, as it can often feel like you don’t own it. We get better at the things we do, and the better you get at producing feel-good chemicals from exercise, the easier it is to produce them in general.
As a general rule, we use the following when introducing strength training to a Fibro client:
Do they understand it?
Do they enjoy it?
Is it not overly complicated?
Is it needed?
Is the client’s nervous system able to deal with the stress?
If the answer is yes, strength training is in. Bear in mind that it is important to lay the groundwork in the form of education and changing the narrative around pain before jumping in at the deep end and picking up a weight.
When we begin a strength training journey there are some common themes which always occur.
Number one is the person gets a sense of achievement. Having not done much for a long time, the sense of pleasure from completing a new movement task can be like a drug. With very good reason, the brain is like a pharmacy and in its cabinet are some of the most potent drugs known to man. The use of movement, strength training or otherwise, helps this mushy pharmacist release those “feel good” chemicals (namely Dopamine and Endorphins) These chemicals give us the feeling of having achieved something and craving it again.
This is why it is so important to address any factors pertinent to YOUR pain before beginning as this process can be just as easily a negative one.
Number 2 is the person will start to notice changes in their body. Weight loss, changing shape, muscles popping up and even muscle soreness will all occur pretty early into the process. Muscle soreness is a weird one. It can be scary to think the pain is being made worse by exercise, but on the other hand, it is an excellent way to prove that although the soreness comes, it goes just as quick. And this can be where the magic truly happens. When you have tangible, physical proof that the body can repair and recover, the associated sensitivity from chronic pain starts to dial down over time and you become much more resilient. Both physically and mentally. After all, a good way to show your brain that your body isn’t damaged is to show it what it can do. Remember earlier when we said that if a brain doesn’t know what movement causes pain, it will just guess? Well actually moving is a good way to for your brain to figure this out.
Number 3 is catching momentum. Once you have experienced a change in your symptoms for the better, the nervous system craves movement. You’ll be itching to move more and actually look forward to exercising. At this stage, the movement has become a tonic and is much more energy-producing than fear-inducing or painful. Again, it all comes down to the narrative and having someone guide you through the process to help address the underlying issue as to why you have Nociplastic pain in the first place.
A Spanish study, of 33 women with fibromyalgia, demonstrated that: “a warm water pool-based exercise program for 12 weeks (2 times/week) led to a positive immediate decrease in the level of pain in female patients with fibromyalgia.” The women involved in the study also reported feeling less depressed and more sociable, as a side benefit of their swimming programme.
Swimming gives someone with Fibromyalgia a chance to exercise without having too much load on their tissues, meaning the alarm system is going to be a lot more forgiving than it normally would be. However, there is one issue with swimming as an exercise for fibro: It’s just not transferable to everyday life. Once you are out of the pool and subject to the same load and gravity that is normally enacted upon you, are you going to be able to deal with that stressor? Unfortunately, there isn’t any research on this so it stays as food for thought.
The name Osteoarthritis is somewhat of a misnomer, as “Osteo” means bone,”‘Arth” means joint, and “Itis” means inflammation. And when we realise that Osteoarthritis is a degenerative condition, not an inflammatory one, we can start to see why there is likely so much misinformation around fibromyalgia and osteoarthritis, especially considering it’s not even named correctly!
There is a lot of misinformation around Osteoarthritis, even more around Fibromyalgia, and an absolute abundance around exercise. So, let’s take a look at some studies and start to break down those damaging narratives that you have likely been told or have read.
One study focusing on professional football players found that 92% of football players had at least 1 spinal degenerative condition, but in some cases, more than 6 were found. The interesting thing was that none of them reported any pain. This is a nice study that helps us look at the complexities of pain, as when it comes to chronic pain it isn’t always about the tissue.
There is a ridiculous amount of evidence that shows us that pain is not tightly linked to tissue damage. And when it comes to Osteoarthritis, there should also be evidence of people with severe degeneration shown on a scan, but who feel fine, and vice versa. This study of 113 people found exactly that, a huge disconnect between degeneration and pain. In which they found that the people with less degeneration had more pain, and those with more degeneration had less pain!
As we mentioned earlier, those with Fibromyalgia suffer from abnormalities in the way that the brain deals with pain. Supraspinal processes have a top-down enhancing effect on nociceptive processing in the brain and spinal cord. Studies have begun to suggest that such influences occur in conditions such as fibromyalgia. This means that those who do have Fibromyalgia may be far more sensitive to noxious stimuli compared to the general population. Factoring in changes at the joint, those with Fibromyalgia may be more prone to reacting to these changes byways of producing pain.
There have been a few studies that have looked into how Fibromyalgia may affect Osteoarthritis. One such study published in the European Journal of Neuroscience, measured brainwaves in response to short painful laser pulses on the skin of patients suffering from osteoarthritic and fibromyalgia pain, as well as test subjects who had no underlying pain. Scientists discovered that the insula cortex part of the brain increased its activity when expecting a painful pulse, as it predicts the extent and intensity of the patients’ own chronic pain.
It is important to keep in mind, that increased activity in this brain area has been linked to a number of phenomena, including body perception and emotional processing, which might explain the greater pain perception in some patients.
In essence, there are a lot of factors that come with fibromyalgia that can make osteoarthritis worse, when compared to individuals without it. One such factor is sleep disturbances. It is well documented that with sleep disturbances and lack of sleep, comes an increase in pain. For those with Fibromyalgia, getting a good, restful night’s sleep can be somewhat of a challenge due to pain. Meaning that it has the potential to create a breeding ground for worsening the symptoms of not just fibromyalgia pain, but also the pain of Osteoarthritis.
The take away though, is that changes and sensitisations seem to be the pain driving forces of osteoarthritis. While you may worry that exercising with osteoarthritis (OA) could harm your joints and cause more pain, research shows that people can and should exercise when they have osteoarthritis. In fact, exercise is considered the most effective, non-drug treatment for reducing pain and improving movement in patients with osteoarthritis.
Conclusion
We have looked at some of the many issues that present when it comes to Fibromyalgia and exercise, and we have looked at the research on the different forms of exercise. As it stands with everything we have discussed, most likely the safest and most beneficial form of exercise for those with Fibromyalgia is Tai Chi.
Tai Chi looks to give individuals a form of exercise that can be built upon, without adding too much stress to an already stressed system. As we mentioned earlier, the true key is to find the reasons why you have nociplastic pain in the first place. As it is far easier to exercise with reduced pain levels and higher tolerance.
We hope you enjoyed reading this and we especially hope we managed to answer some of your burning questions.
At the end of the day, pain is multifactorial and comes down to hundreds of interplaying factors.
When you’re in pain, you have one thing on your mind – please make it stop. Luckily there are many pain management options out there, some work faster than others, and some even have an immediate effect. And while opioids can serve an important function, my advice for patients is to try a non-medication approach first. The following pain-relief tips are sustainable and most importantly they’re often times effective for many types of pain conditions when combined with a comprehensive treatment plan.
Being active is great for your health as seen in many studies. It can help strengthen muscles and extend your life, when combined with a comprehensive pain management routine. Any physical activity should first be discussed with your doctor, and be adjusted based on your ability to tolerate your symptoms and function; however, there are plenty of low-impact exercises that can have a positive impact on your pain. Walking is one of them. It can be done anytime and almost anywhere, and the simple act of moving can work wonders on relieving certain symptoms, especially chronic back pain. Some ideas on how to incorporate walking into your daily routine could include: take your dog for a quick stroll first thing in the morning when you may be feeling especially stiff, choose the farthest parking space, use the office restroom or the walking route that’s out of your way at work.
Massage is a popular pain-relief option due to its many pain-relieving benefits; however, making an appointment at the spa can be prohibitive due to time and cost. So if you are one of the many individuals whose day is filled with work, errands and other responsibilities, a handheld at-home massager can be a much needed relief. For example, the Wahl Deep Tissue Massager is one of the most powerful massagers currently available. It offers customized relief through a combination of interchangeable heads and variable intensity control.
One of the biggest advantages of incorporating at-home massage into a comprehensive pain-management regimen is convenience and the fact that it provides relief fast. Massage relieves muscle tension by enhancing blood flow, which causes muscles to relax. It also decreases inflammation by activating genes that can naturally reduce swelling, it reduces pain intensity by diminishing bodily substances that create and prolong pain and it improves recovery by stimulating mitochondria, the “energy packs” driving cellular function and repair.
Water can be an easy way to stem pain at the source. Keeping water nearby and making sure you drink at least eight 8-ounce glasses daily can make all the difference when trying to combat pain. In general, your body needs water to work properly, to lubricate and cushion your joints, to protect your tissues, to keep your temperature normal and to get rid of wastes. A lack of water can lead to dehydration and drain your energy even further, leading to exhaustion and more painful symptoms. Water is a key element in keeping balance in your body and overall health.
I already covered the miraculous effect water can have on your body from the inside, but it has soothing powers from the outside too. Depending on the source or your chronic pain, a warm bath can offer respite from your discomfort. Being submerged in water reduces the stress of body weight and gives all-over support, easing pressure on your joints. What’s more, the warm and even temperature stimulates blood flow throughout your body helping to loosen stiff, painful muscles.
